Knowing When to Stop: The Limits of Medicine

Abstract

Enshrined in modern medicine is a distinct set of values. When medicine assumes these values uncritically, a host of ethical problems results. A glimpse at ancient roots of modern medicine reveals that an older scientific tradition entertained a very different set of values--values that provide wise counsel and shed light on specificf ethical concern of providing medically futile care patients. Hippocratic Medicine Hippocratic physicians in fifth through third centuries B.C. were among first question ethical limits of Historians regard one of their achievements be an understanding of when and when not intervene. In a work attributed Greek physician Hippocrates, it is written that purpose of medicine is to do away with sufferings of sick, lessen violence of their but also to refuse treat those who are overmastered by their diseases, realizing that in such cases medicine is powerless. According this tradition, knowing limits of medicine is related physician's appreciation of art of medicine and power of nature (physis). The predominant meaning of nature in Hippocratic corpus is the essential substances which make up human beings. The physician searched for human being's natural state of health that had been altered by changes wrought by disease. The Hippocratic writings caution that should a physician demand an art power over what does not belong art, or from nature a power over what does not belong nature, his ignorance is...allied madness. [1] For Greeks, medicine is techne, which implies doing. In doing, one is bound...by potentialities of object...[and] by those of techne itself. [2] According this tradition, only physician who understands natural limits and uses this understanding set wise boundaries avoids error of excessive confidence. The Greeks called this error hubris, and tone of their approach counseled against In words of one historian, Those who disregarded natural scope of therapies stained authority of medicine. [3] The basis for moderation and atttention limits in Hippocratic medicine reflects medical theories upon which Hippocratic medicine was built. Ancient medicine conceived its task be one of working with human nature assist in restoring disruptions in its natural order. Thus author of Precepts enjoined physicians display discoveries of art, preserving nature, not trying alter it. [4] This viewpoint developed out of Greek understanding of human health and disease. Health was viewed as a natural balance of four bodily humors (yellow bile, blood, black bile, and phlegm); disease was defined as an imbalance among these four. For example, a fever meant that too much yellow bile, and so too much heat and dryness, was present in body. To restore health, a physician might instruct that water be used as a cooling agent: patient might consume fluids or be immersed in cool water baths. Hippocratic physicians emphasized importance of environment and climate in maintaining a natural balance within body. Since human beings are under influence of their essence or nature, in situations where disease is incurable physician must accept that medical means should not be used. The spirit of this approach is described by Plato, who extolled kind of medicine taught by followers of Asclepius. In Republic, Plato emphasizes that Asclepius...taught medicine for those who were healthy in their nature...but were suffering from a specific disease; he rid them of it...then ordered them live as usual....For those, however, whose bodies were always in a state of inner sickness he did not attempt prescribe a regimen, or...to make their life a prolonged misery...Medicine was not intended for them and they should not be treated, even if they were richer than Midas. …